Tips and tricks for hysteroscopic resection of a large type I submucosal fibroid: a video presentation.

We present a step-by-step approach for hysteroscopic myomectomy in patients with submucosal fibroids, focusing on key surgical techniques that enhance safety, preserve uterine integrity, and ensure complete fibroid removal. A 49-year-old woman with heavy menstrual bleeding presented with a type I submucosal fibroid measuring 32 × 23 × 20 mm. The procedure was performed using a 27 Fr bipolar resectoscope. Intraoperative strategies include: minimal cervical dilation to reduce fluid leakage, continuous saline infusion with controlled suction for optimal visibility, avoidance of repeated scope removal to maintain intrauterine pressure and identification of myometrial margins to ensure complete resection and prevent perforation. This video highlights essential surgical techniques and intraoperative considerations for performing safe and effective hysteroscopic myomectomy. Attention to fluid management, visualization, and preservation of cervical and uterine integrity is critical for optimal outcomes, especially in women with prior uterine surgery or fertility concerns.